Risk of suicide during treatment with venlafaxine, italopram, fluoxetine, and dothiepin : retrospective cohort study

Objective To compare the risk of suicide in adults usingthe antidepressant venlafaxine compared with citalopram, fluoxetine, and dothiepin. Design Retrospective cohort study. Setting UK General Practice Research Database. Participants 219 088 patients, aged 18-89 years, who were prescribed venlafaxine, citalopram, fluoxetine, or dothiepin from 1995 to 2005. Main outcome measures Completed suicide and attempted suicide. Results Venlafaxine users had a higher burden of risk factors for suicide, includingprevious suicide attempts and proxies for severe depression or depression that was difficult to treat. In the analysis for completed suicides, unadjusted and adjusted hazard ratios for venlafaxine compared with citalopram were 2.44 (95% confidence interval 1.12 to 5.31) and 1.70 (0.76 to 3.80), for venlafaxine compared with fluoxetine were 2.85 (1.37 to 5.94) and 1.63 (0.74 to 3.59), and for venlafaxine compared with dothiepin were 2.54 (1.07 to 6.02) and 1.31 (0.53 to 3.25). Compared with other study drugs, venlafaxine was also associated with an increased risk of attempted suicide, but adjustment for measured confounders substantially reduced the hazard ratios. Conclusions Venlafaxine use was consistently associated with higher risk of suicide compared with citalopram, fluoxetine, and dothiepin. Venlafaxine users had a higher burden of suicide risk factors, however, and adjustment for measured confounders substantially reduced the excess risks. Since the secondary data used in this analysis allowed only indirect and partial measurements of potential confounders, it is possible that residual confounding explains much, if not all, of the observed excess risk

Swallows and Amazons, or the Sporting Exception To the Gender Recognition Act

The Gender Recognition Act 2004 purports to restrict transgendered persons’ opportunities to participate in sports if their involvement is not conducive to either ‘competitive fairness’ or ‘safety’. This article considers the difficulties in founding a prohibition on either ground, through reference to the medical literature and by considering relevant developments in other jurisdictions. It works towards a theoretical framework for consideration of the broader issues concerning sport and sexed/gendered bodies by suggesting that transgender sport may be regarded as a struggle over the legitimate use of the sporting body; and one that both reinforces and challenges the significance of sports as a gendering practice